Rebecca Cicero/Owen Davies
Social Services Improvement Agency
August 2016
Social Care Wales: improvement functions and priorities
Summary
1. This paper provides advice and recommendations on SCW’s improvement function, on suggested early priorities, and on proposed next steps to develop these priorities further. The advice and recommendations have been developed by the Social Care Wales Improvement Sub-Group and subsequently through consultation with the sector. A full report of the outcome of engagement activity is also provided ((Developing Improvement Priorities for Social Care Wales – Outcome of engagement activity).
Social Care Wales Improvement Sub-group
2. In March 2015, the then Minister for Health and Social Services announced the establishment of a Transition to Social Care Wales Advisory Panel. Chaired by Arwel Ellis Owen, the Panel was tasked to develop by March 2016 a transition plan.
3. The Advisory Panel established a number of sub groups to support its work, including in September 2015 a sub-group to consider the improvement function of Social Care Wales building on the work previously undertaken by the Strategic Improvement Steering Group (SISG). The sub group reported back to the Panel in December 2015, and its findings are summarized below. These formed part of the Panel’s report to the Minister in March 2016. The Minister confirmed his acceptance of the Panel’s report and recommendations in April 2016, via a Written Statement.
SCW values
4. The sub-group made a number of wide ranging recommendations about the improvement functions of SCW. Firstly, it highlighted the importance of SCW setting out the values and principles under which it will operate across the range of its functions. In respect of improvement, these values needed to include:
· Improving well-being - the overall ambition of SCW should be tocontribute to improving the well-being of people in Wales. This means improving the quality of services but should also encompass improving the efficiency with which good services are delivered. SCW should ensure as far as possible that its activity is aligned with the well-being statements produced by Welsh Ministers
· Outcome focused – the focus of all improvement work must be on securing improved outcomes for citizens and its work should cover the whole of the social care sector
· Focusing on the evidence - SCW should be an evidence-based organisation. This means seeking and confirming agreement on what 'good' looks like, that what works should continue, and that only evidence based best practice should be promoted. It will also need to recognise that where evidence is not clear-cut, and in such circumstances should work to strong hypotheses about what works based on the best available evidence. However, SCW should also be an organisation prepared to support innovation, and to take (or support others to take) risks on promising but unevaluated practice where this is appropriate
· Supporting and challenging service providers and service commissioners – SCW should support services to improve and must act as a critical friend. It will need to win the confidence of service providers, and become a trusted source of advice, guidance and support. However, it should not be afraid to challenge robustly - but constructively - where necessary
· Listening to the citizen – SCW must listen to the voice of the citizen – people with social care and well-being needs and their carers, and those who advocate on their behalf – and communicate in such a way as to ensure citizens understand its role, so that citizens understand what good practice is, can ask for it, and can challenge service providers and service commissioners if good practice is not being delivered.
· Championing the social care sector – SCW should highlight the role of the social care sector in improving well-being and thus the wider health of the nation, in more ways than simply improving lives. Supporting people to improve their well-being can help them to play a more active role in society, whilst effective prevention within the social care sector can reduce the burden on other services. The positive economic impact of the social care sector should also be promoted.
Approach to improvement
5. The sub-group supported the aspiration for SCW to take a strategic approach to improvement across the whole of the social care sector, provided this strategic focus does not exclude the bottom-up, grass-roots approaches to improvement recommended as an essential element of SCW’s improvement activity. SCW’s role should include both transformative change – making services better through major service redesign and reconfiguration; and incremental change - making smaller changes to existing service delivery, where SCW could facilitate locally/regionally led approaches to improvement, involving front-line workers in improvement activity.
6. Over time, SCW should establish itself as a leader for improvement activity. This means having a ‘place’ for improvement support that is recognised, understood and trusted. It does not mean SCW should try to do everything, but it should be recognised as a place where the full range of improvement activity being undertaken is understood and given coherence. The provision of advice on evidence based good practice, and the development of toolkits to help with the delivery/improvement of specific statutory duties or functions, will be important elements, which should feature in SCW’s improvement model. This could be modeled on the Scottish Care Inspectorate’s Hub, which provides access to a range of resources aimed at supporting improvement in social care. The analysis of data and information about existing practice, and the synthesising of research evidence, into a format that can inform the improvement of services, will also be a potential priority for SCW improvement activity.
7. However, there is a balance (and potential tension) between being evidence based, and encouraging and supporting innovative practice and accepting the element of risk which inevitably accompanies the testing of new approaches to service delivery. SCW should have freedom to support innovation where appropriate.
8. In addition to being a strategic leader and driver of change, SCW would ideally have the capacity to take an active, hands-on role in improvement, through the provision of expertise and support to bodies with a social care function, giving it the capability both to identify what works, and to provide practical help and support to social care providers to implement change. However, the extent to which SCW will be able to provide such support will depend very much on the resources made available to it.
Priorities – initial proposals
9. The sub-group’s proposals for SCW’s improvement function included a recommendation that SCW should not aim for a ‘big bang’ in April 2017, but should identify 3-5 initial priorities. The sub-group identified some potential priorities, but was clear that SCW must have flexibility and freedom to determine its own programme of work. In respect of initial improvement priorities, the sub-group considered whether any early priorities for SCW could be identified. The sub-group did not make firm recommendations, but proposed three potential priorities for improvement activity:
· Improving services and outcomes for looked after children
· Improving services and outcomes for people with dementia
· Supporting the domiciliary care workforce to enable it to comply with the new registration requirements
10. The sub-group recognised that the number of people with dementia in Wales is rising, a trend which is common across the world. There are currently just over 37,000 people living with dementia in Wales, and the effect on the individual is different in each case. By 2021, the number of people with dementia across Wales is projected to increase by 31% and by as much as 44% in some rural areas. The challenge of addressing the impact on rural communities is a particular issue in Wales, as well as the Welsh Language which is especially important for those who may only be able to communicate in their first language as their illness progresses. The sub-group suggested that given the significant and rising impact of dementia on individuals and communities in Wales, there is a potentially important role for SCW in helping to improve the social care services people with dementia receive.
11. The sub-group noted the concerns expressed by Ministers about the increase in the numbers of Looked After Children (LAC) since 2003, and the inconsistency between the numbers of children in care across often neighbouring authorities. Figures for 2013-14 show that over the last decade, the number of LAC in Wales has increased by 37%, from 4,194 in 2002-03 to 5,756 as at 31 March 2014. This represents a rate of 91 per 10,000 population aged under 18, with an equivalent rate for England at 60 per 10,000 population aged under 18. Similar increases in the number and the overall rate have not been experienced in England.
12. The sub-group were aware that Ministers are keen for a greater focus on helping support families to stay together, when appropriate, and improved early intervention and preventative action with families before problems arise and become more complex. Ministers have indicated they wish to see a change in culture to one of supporting families and to consistently improving outcomes for those children that do need to be taken into care. The sub-group concluded that SCW could play an important role in helping to deliver this change.
13. In respect of domiciliary care, the sub-group highlighted the significant challenges facing the sector including resource constraints, workforce pressures, and the requirements for registration of domiciliary care workers from 2020. In the light of this, the Minister has subsequently determined that work to improve domiciliary care will be one of SCW’s early priorities.
Priorities – further work
14. The sub-group recommended the transition year should be used to test out further whether these initial priorities are the right ones. The Welsh Government therefore asked SSIA in April 2016 to conduct work to engage with the social care sector, in order to further explore these potential improvement priorities identified for SCW.
15. SSIA developed a proposed approach to the task, and agreed this with Welsh Government officials and with the Care Council for Wales. In order to gather a wide range of views, SSIA asked stakeholders to complete an online survey, and held six in-depth focus groups across Wales. For the survey, respondents were asked for their views on the sub-group’s proposed priorities, and the cross cutting priorities previously identified. The survey ran between 10 May and 24 June, and 152 responses were received. A total of 63 attendees participated in the focus groups, at which they were asked to discuss in more detail the priority areas of dementia, domiciliary care and looked after children, as well as identifying any additional areas they felt should be a priority for Social Care Wales. An Improvement Task and Finish Group, chaired jointly by the WLGA Director for Social Services and Housing and the CE of the Care Council for Wales.
16. The results of this exercise have been analysed, and have demonstrated very strong levels of support for the three priorities identified, as well as for the principles and values for improvement recommended by the Improvement Sub-Group and included in the Advisory Panel’s report to the Minister.
17. Respondents to the online survey and participants in the focus groups were asked to provide more detail about the sorts of things SCW should focus on. Analysis of these responses has been developed into a series of recommendations, which fall broadly into two key themes:
· Driving improvement and innovation through research, and evidence on best practice. This includes:
o Working with research partners to interpret research about models of care, and provide advice and support on implementing change successfully and sustainably
o Developing hubs and networks to make evidence and data more easily accessible
o Supporting co-productive working between citizens and the sector
o Supporting preventative approaches
· Supporting improvement and sustainability in and through the workforce. This includes:
o Cross sectoral approaches to training and development, including a focus on the skills needed to deliver outcomes based care
o Promoting the sector to improve recruitment and retention
18. The recommendations under these themes are listed in the table below, and the full report of this exercise is attached (Developing Improvement Priorities for Social Care Wales – Outcome of engagement activity).
19. Respondents were also asked to suggest other possible priorities for SCW. A wide range of suggestions were received. Support for families and unpaid carers emerged as a specific candidate for SCW activity, whilst broader themes including workforce training, early intervention and prevention, and the use of technology were also proposed. These broader themes are reflected in the recommendations in the table.
20. Respondents were also keen to stress the importance of recognising that SCW could not and should not do everything, but needed to focus its efforts on where it could have the greatest impact and where its work would complement other activity aimed at improving services for those in the priority groups identified.
Table: Proposed improvement recommendations for Social Care Wales – dementia, looked after children, and domiciliary care
Driving improvement and innovation through research and evidence /Ways of working / Priorities and actions /
Work with research partners to interpret research about models and approaches in care, and support sector to identify solutions for their particular circumstances / Dementia
Identify, interpret and share data and research about models of practice
· Identify and share research findings on models and frameworks designed to support people with dementia – including dementia friendly communities – and offer interpretation of what that research means and practical advice on implementation
· Examine and disseminate appropriate models of respite (short term care and breaks)
· Disseminate learning on successful early intervention approaches in supporting people with dementia – including reablement – and drive implementation of best practice
Domiciliary Care
Explore and disseminate information about alternative delivery models in home care, that are more suited to meeting individual outcomes:
· Identify and evaluate flexible, person-centred models for delivering home care that address pressures within the sector